Infection prevention and control


Antimicrobial copper surfaces in an ICU at one of the trial facilities – the Ralph H. Johnson VA Hospital.


EPA registration The EPA registration covers the following claims:  This surface continuously reduces bacterial contamination, achieving 99.9% reduction within two hours of exposure.


 This surface kills greater than 99.9% of Gram-negative and Gram-positive bacteria within two hours of exposure.


 This surface delivers continuous and ongoing antibacterial action, remaining effective in killing greater than 99.9% of bacteria within two hours.


 This surface kills greater than 99.9% of bacteria within two hours, and continues to kill more than 99% of bacteria even after repeated contamination.


 This surface helps inhibit the build-up and growth of bacteria within two hours of exposure between routine cleaning and sanitising steps.


More recently, Professor Keevil’s group developed a dry touch simulation test which showed an even faster rate of kill: a log 6 reduction of Vancomycin-resistant Enterococcus in under 10 minutes.3


The


limitations of current test standards have been acknowledged by the British Standards Institution, which set up a panel last year to develop a standard comprising a suite of tests designed to reflect different in situ uses, not only for healthcare, but also for food processing applications.


Clinical trials – Bioburden reduction The laboratory findings provided compelling evidence of copper’s broad spectrum and rapid antimicrobial efficacy, and were a vital step on the path towards clinical trials that took research to the next stage, and asked the question: ‘Can copper reproduce this efficacy in a busy and challenging clinical environment?’


66 Health Estate Journal September 2013


An antimicrobial copper-equipped bathroom at Selly Oak Hospital, Birmingham.


The first trial to answer that question


was conducted at Selly Oak Hospital, Birmingham, where a general medical ward was fitted out with a suite of copper alloy components, which were sampled over many months to assess bioburden. Results were compared with control surfaces on the same ward during the same period, and demonstrated a 90-100% reduction in bioburden on the copper items.4 Other trials followed, and confirmed


these findings, but the largest trial to date was carried out in the US, and funded by the country’s Department of Defense. The aim of this particular trial was to go to the next level, and look at impact of reduced bioburden on infection rates.


Link between environmental contamination and infection A clinical trial designed to explore any possible link between copper’s continuous antimicrobial action, and infection rates, was conducted by infectious disease clinicians, and led by Dr Cassandra Salgado, associate professor at the Medical University of South Carolina’s Department of Medicine. The trial was conducted in three medical centres: The Medical University of South Carolina (MUSC) – a 660-bed tertiary care, academic hospital with 17 medical ICU beds; Ralph H. Johnson Veterans Administration Medical Center – a 98-bed hospital with eight medical ICUs, and the Memorial Sloan Kettering Cancer Center in New York City – a 460-bed academic cancer hospital with 20 medical-surgical ICU beds. The trial lasted 43 months in total. and was conducted in three phases. In Phase One, the microbial burden


associated with six commonly touched surfaces in the 16 ICU rooms was determined using weekly sampling and standard microbial techniques. The surfaces were those in closest proximity to the patient: bed rails, over-bed tables,


call buttons, chair arms, data input devices, and IV drip poles. For the second phase of the study,


these six surfaces were replaced with antimicrobial copper in half of the study rooms across the three hospitals (three copper and three controls at MUSC and Memorial Sloan Kettering, and two copper and two control at Ralph H. Johnson), and weekly sampling continued on these and comparable items in the control rooms for a further 21 months.


in bioburden Copper was found to cause a significant (83%) reduction in the average microbial burden found on the six objects (465 colony forming units/100 cm2


Significant reduction ;


n 2714 objects), compared to the controls (2,674 cfu/100 cm2


; n 2,831 objects).5 The authors concluded from the


Phase Two results that: ‘The introduction of copper surfaces to objects formerly covered with plastic, wood, stainless steel, and other materials found in the patient care environment, significantly reduced the overall MB on a continuous basis, thereby providing a potentially safer environment for hospital patients, healthcare workers, and visitors’. The total surface area of the copper


alloy objects represented less than 10% of the total touch surface area within the ICUs.


Trial’s third phase In the third phase of the trial, patient infection and colonisation rates were compared over a period of one year after the copper items were installed.6


Overall,


the proportion of patients who developed an HCAI was 58% lower among those randomly assigned to ICU rooms containing objects made from antimicrobial copper than those who were assigned to control rooms. Perhaps even more interestingly, in terms of relating


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